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Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature277099
Source
Eur J Cardiothorac Surg. 2016 Feb;49(2):391-7
Publication Type
Article
Date
Feb-2016
Author
Kristinn Thorsteinsson
Kirsten Fonager
Charlotte Mérie
Gunnar Gislason
Lars Køber
Christian Torp-Pedersen
Rikke N Mortensen
Jan J Andreasen
Source
Eur J Cardiothorac Surg. 2016 Feb;49(2):391-7
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Comorbidity
Coronary Artery Bypass - mortality
Coronary Artery Disease - mortality - surgery
Denmark - epidemiology
Elective Surgical Procedures - mortality
Emergency Treatment - mortality
Female
Humans
Kaplan-Meier Estimate
Length of Stay
Male
Middle Aged
Postoperative Complications - mortality
Retrospective Studies
Abstract
An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG.
All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan-Meier curves.
A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60-69 years), 10.7 years (70-74 years), 8.9 years (75-79 years) and 7.2 years (=80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients 80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13-17%, diabetes 12-21%, stroke 9-11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41-7.50], emergency surgery (HR: 5.23, 95% CI: 4.38-6.25).
Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.
Notes
Comment In: Eur J Cardiothorac Surg. 2016 Feb;49(2):397-826242898
PubMed ID
25698155 View in PubMed
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Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery.

https://arctichealth.org/en/permalink/ahliterature266490
Source
Circ Cardiovasc Qual Outcomes. 2015 Jan;8(1):103-8
Publication Type
Article
Date
Jan-2015
Author
Charlotte Andersson
Mads Wissenberg
Mads Emil Jørgensen
Mark A Hlatky
Charlotte Mérie
Per Føge Jensen
Gunnar H Gislason
Lars Køber
Christian Torp-Pedersen
Source
Circ Cardiovasc Qual Outcomes. 2015 Jan;8(1):103-8
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Age Factors
Aged
Aged, 80 and over
Brain Ischemia - etiology
Cardiovascular Diseases - diagnosis - etiology - mortality
Comorbidity
Decision Support Techniques
Denmark
Elective Surgical Procedures
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - etiology
Odds Ratio
Registries
Retrospective Studies
Risk assessment
Risk factors
Stroke - etiology
Surgical Procedures, Operative - adverse effects - mortality
Time Factors
Treatment Outcome
Abstract
The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship of RCRI with major adverse cardiovascular events in an unselected cohort of patients undergoing elective, noncardiac surgery overall and in different age groups.
We followed up all individuals = 25 years who underwent major elective noncardiac surgery in Denmark (January 1, 2005, to November 30, 2011) for the 30-day risk of major adverse cardiovascular events (ischemic stroke, myocardial infarction, or cardiovascular death). There were 742 of 357,396 (0.2%), 755 of 74.889 (1.0%), 521 of 11,921 (4%), and 257 of 3146 (8%) major adverse cardiovascular events occurring in RCRI classes I, II, III, and IV. Multivariable odds ratio estimates were as follows: ischemic heart disease 3.30 (95% confidence interval, 2.96-3.69), high-risk surgery 2.70 (2.46-2.96), congestive heart failure 2.65 (2.29-3.06), cerebrovascular disease 10.02 (9.08-11.05), insulin therapy 1.62 (1.37-1.93), and kidney disease 1.45 (1.33-1.59). Modeling RCRI classes as a continuous variable, C statistic was highest among age group 56 to 65 years (0.772) and lowest for those aged >85 years (0.683). Sensitivity of RCRI class >I (ie, having = 1 risk factor) for capturing major adverse cardiovascular events was 59%, 71%, 64%, 66%, and 67% in patients aged = 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups.
In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having = 1 risk factor was of moderate sensitivity, but high negative predictive value for all ages.
PubMed ID
25587095 View in PubMed
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Anatomic feasibility of endovascular reconstruction in aortic arch aneurysms.

https://arctichealth.org/en/permalink/ahliterature261905
Source
Vascular. 2015 Feb;23(1):17-20
Publication Type
Article
Date
Feb-2015
Author
B. Sonesson
M. Landenhed
N. Dias
T. Kristmundsson
R. Ingemansson
B. Koul
M. Malina
T. Resch
Source
Vascular. 2015 Feb;23(1):17-20
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Aged
Aorta, Thoracic - radiography - surgery
Aortic Aneurysm, Thoracic - diagnosis - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - instrumentation
Elective Surgical Procedures
Endovascular Procedures - instrumentation
Feasibility Studies
Female
Humans
Male
Middle Aged
Predictive value of tests
Prosthesis Design
Reconstructive Surgical Procedures - instrumentation
Stents
Sweden
Tomography, X-Ray Computed
Treatment Outcome
Abstract
The purpose was to estimate the proportion of current open aortic arch reconstructions that might be feasible for endovascular repair. From all elective repair made in Southern Sweden in one center between 2005 and 2012, 129 open and eight endovascular aortic arch repairs were identified. The anatomy of the ascending arch and descending aorta as well as the arch vessels was categorized from multiplanar and axial computed tomography scans. Of 129 open cases, only two (1.5%) were suitable for endovascular repair. Among 137 all arch open and endovascular arch reconstructions performed during the study period, only 10 (7%) were candidates for endovascular repair. The most common exclusion for endovascular repair was an excessively large ascending aortic diameter. In conclusion, only a small proportion of patients having an open arch repair are suitable for endovascular arch repair, a finding related to the large diameter of the ascending aorta.
PubMed ID
24621558 View in PubMed
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Assessment of post-operative pain management among acutely and electively admitted patients - a Swedish ward perspective.

https://arctichealth.org/en/permalink/ahliterature279455
Source
J Eval Clin Pract. 2016 Apr;22(2):283-9
Publication Type
Article
Date
Apr-2016
Author
Mahnaz Magidy
Margareta Warrén-Stomberg
Kristofer Bjerså
Source
J Eval Clin Pract. 2016 Apr;22(2):283-9
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Elective Surgical Procedures
Female
Hospitals, University - organization & administration
Humans
Male
Middle Aged
Pain Management - methods
Pain Measurement
Pain, Postoperative - therapy
Patient satisfaction
Quality Indicators, Health Care
Quality of Health Care - organization & administration
Sex Factors
Socioeconomic Factors
Sweden
Abstract
Swedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery.
A survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospital's surgical department were included. Data collection was performed at hospital discharge.
In total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted.
There may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good.
PubMed ID
26507572 View in PubMed
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Association Between Obstetric Mode of Delivery and Autism Spectrum Disorder: A Population-Based Sibling Design Study.

https://arctichealth.org/en/permalink/ahliterature268219
Source
JAMA Psychiatry. 2015 Sep;72(9):935-42
Publication Type
Article
Date
Sep-2015
Author
Eileen A Curran
Christina Dalman
Patricia M Kearney
Louise C Kenny
John F Cryan
Timothy G Dinan
Ali S Khashan
Source
JAMA Psychiatry. 2015 Sep;72(9):935-42
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Autism Spectrum Disorder - epidemiology
Cesarean Section - statistics & numerical data
Child
Cohort Studies
Delivery, obstetric - statistics & numerical data
Elective Surgical Procedures - statistics & numerical data
Emergencies
Extraction, Obstetrical - statistics & numerical data
Female
Humans
Incidence
Logistic Models
Male
Odds Ratio
Pregnancy
Proportional Hazards Models
Siblings
Sweden - epidemiology
Abstract
Because the rates of cesarean section (CS) are increasing worldwide, it is becoming increasingly important to understand the long-term effects that mode of delivery may have on child development.
To investigate the association between obstetric mode of delivery and autism spectrum disorder (ASD).
Perinatal factors and ASD diagnoses based on the International Classification of Diseases, Ninth Revision (ICD-9),and the International Statistical Classification of Diseases, 10th Revision (ICD-10),were identified from the Swedish Medical Birth Register and the Swedish National Patient Register. We conducted stratified Cox proportional hazards regression analysis to examine the effect of mode of delivery on ASD. We then used conditional logistic regression to perform a sibling design study, which consisted of sibling pairs discordant on ASD status. Analyses were adjusted for year of birth (ie, partially adjusted) and then fully adjusted for various perinatal and sociodemographic factors. The population-based cohort study consisted of all singleton live births in Sweden from January 1, 1982, through December 31, 2010. Children were followed up until first diagnosis of ASD, death, migration, or December 31, 2011 (end of study period), whichever came first. The full cohort consisted of 2,697,315 children and 28,290 cases of ASD. Sibling control analysis consisted of 13,411 sibling pairs.
Obstetric mode of delivery defined as unassisted vaginal delivery (VD), assisted VD, elective CS, and emergency CS (defined by before or after onset of labor).
The ASD status as defined using codes from the ICD-9 (code 299) and ICD-10 (code F84).
In adjusted Cox proportional hazards regression analysis, elective CS (hazard ratio, 1.21; 95% CI, 1.15-1.27) and emergency CS (hazard ratio, 1.15; 95% CI, 1.10-1.20) were associated with ASD when compared with unassisted VD. In the sibling control analysis, elective CS was not associated with ASD in partially (odds ratio [OR], 0.97; 95% CI, 0.85-1.11) or fully adjusted (OR, 0.89; 95% CI, 0.76-1.04) models. Emergency CS was significantly associated with ASD in partially adjusted analysis (OR, 1.20; 95% CI, 1.06-1.36), but this effect disappeared in the fully adjusted model (OR, 0.97; 95% CI, 0.85-1.11).
This study confirms previous findings that children born by CS are approximately 20% more likely to be diagnosed as having ASD. However, the association did not persist when using sibling controls, implying that this association is due to familial confounding by genetic and/or environmental factors.
PubMed ID
26107922 View in PubMed
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Association between tubal ligation and endometrial cancer risk: A Swedish population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature297528
Source
Int J Cancer. 2018 07 01; 143(1):16-21
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-01-2018
Author
Henrik Falconer
Li Yin
Daniel Altman
Author Affiliation
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Source
Int J Cancer. 2018 07 01; 143(1):16-21
Date
07-01-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Cohort Studies
Elective Surgical Procedures
Endometrial Neoplasms - epidemiology - mortality
Female
Humans
Incidence
Middle Aged
Registries
Regression Analysis
Sterilization, Tubal - statistics & numerical data
Sweden - epidemiology
Young Adult
Abstract
Tubal ligation results in less advanced stages and lower risk of metastatic spread at diagnosis of endometrial cancer (EC) but the primary preventive effect of the procedure is unclear. In a Swedish nationwide population-based cohort study, we crosslinked registry data for tubal ligation, EC, and death for Swedish women between 1973 and 2010. All women were followed until EC, emigration, hysterectomy for non-cancerous reasons, death, or end of follow-up. Primary outcome was incidence of EC and secondary outcome overall survival. We calculated adjusted incidence rates (IR) per 100,000 person-years and hazard ratios (HR) using Cox regression models. A total of 35,711 cases of EC were identified among 5,385,186 women. The IR of EC among exposed was 17.7 (95% CI 15.7-19.9) versus 29.0 (95% CI 28.7-29.3) among unexposed (per 100,000 women years). Exposed individuals had significantly reduced risk of EC (HR 0.73, 95% CI 0.65-0.83). The mortality rate among women with EC was 72% lower in exposed compared to unexposed (IR 1,441; 95% CI 1,089-1,907 and IR 5,136; 95% CI 5,065-5,209, respectively) which following adjustment corresponded to a HR of 0.71 (95% CI 0.49-1.03). Tubal ligation was associated with lower risk of EC as well as mortality rates in women with EC. Elective tubal ligation may be adopted in future cancer preventive strategies but must be balanced against the irreversibility of the procedure, which preclude further unassisted reproduction.
PubMed ID
29388208 View in PubMed
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Association of Comorbidity with Anastomotic Leak, 30-day Mortality, and Length of Stay in Elective Surgery for Colonic Cancer: A Nationwide Cohort Study.

https://arctichealth.org/en/permalink/ahliterature266856
Source
Dis Colon Rectum. 2015 Jul;58(7):668-76
Publication Type
Article
Date
Jul-2015
Author
Peter-Martin Krarup
Andreas Nordholm-Carstensen
Lars Nannestad Jorgensen
Henrik Harling
Source
Dis Colon Rectum. 2015 Jul;58(7):668-76
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - complications - mortality - surgery
Adult
Aged
Aged, 80 and over
Anastomotic Leak - mortality
Cohort Studies
Colectomy
Colonic Neoplasms - complications - mortality - surgery
Comorbidity
Denmark - epidemiology
Elective Surgical Procedures - adverse effects - mortality
Female
Humans
Length of Stay
Logistic Models
Male
Middle Aged
ROC Curve
Registries
Risk factors
Abstract
Comorbidity has a negative influence on the long-term prognosis in patients with colorectal cancer, whereas its impact on the postoperative course is less clear.
The aim of this study was to investigate the influence of comorbidity on anastomotic leak and short-term outcomes after resection for colonic cancer.
This is a retrospective nationwide cohort study
: Data were obtained from the Danish Colorectal Cancer Group and the National Patient Registry.
Patients with colonic cancer undergoing elective resection between 2001 and 2008 were selected.
The primary outcome was the ability of comorbidity to predict anastomotic leak. Secondary outcomes were 30-day mortality and length of stay. Comorbidity was assessed by the Charlson Comorbidity Index. Multivariable logistic regression and receiver operating characteristics curves were used to adjust for confounding.
The rate of anastomotic leak was 535/8597 (6.2%). The mean (95% CI) Charlson score was 0.83 (0.72-0.94) and 0.63 (0.61-0.66) for patients with and without anastomotic leak, p 2, p
PubMed ID
26200681 View in PubMed
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Birth by Caesarean Section and the Risk of Adult Psychosis: A Population-Based Cohort Study.

https://arctichealth.org/en/permalink/ahliterature279444
Source
Schizophr Bull. 2016 May;42(3):633-41
Publication Type
Article
Date
May-2016
Author
Sinéad M O'Neill
Eileen A Curran
Christina Dalman
Louise C Kenny
Patricia M Kearney
Gerard Clarke
John F Cryan
Timothy G Dinan
Ali S Khashan
Source
Schizophr Bull. 2016 May;42(3):633-41
Date
May-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cesarean Section - adverse effects - statistics & numerical data
Cohort Studies
Delivery, Obstetric - adverse effects - statistics & numerical data
Elective Surgical Procedures - adverse effects - statistics & numerical data
Female
Humans
Male
Psychotic Disorders - epidemiology - etiology
Registries
Sweden - epidemiology
Young Adult
Abstract
Despite the biological plausibility of an association between obstetric mode of delivery and psychosis in later life, studies to date have been inconclusive. We assessed the association between mode of delivery and later onset of psychosis in the offspring. A population-based cohort including data from the Swedish National Registers was used. All singleton live births between 1982 and 1995 were identified (n= 1,345,210) and followed-up to diagnosis at age 16 or later. Mode of delivery was categorized as: unassisted vaginal delivery (VD), assisted VD, elective Caesarean section (CS) (before onset of labor), and emergency CS (after onset of labor). Outcomes included any psychosis; nonaffective psychoses (including schizophrenia only) and affective psychoses (including bipolar disorder only and depression with psychosis only). Cox regression analysis was used reporting partially and fully adjusted hazard ratios (HR) with 95% confidence intervals (CI). Sibling-matched Cox regression was performed to adjust for familial confounding factors. In the fully adjusted analyses, elective CS was significantly associated with any psychosis (HR 1.13, 95% CI 1.03, 1.24). Similar findings were found for nonaffective psychoses (HR 1.13, 95% CI 0.99, 1.29) and affective psychoses (HR 1.17, 95% CI 1.05, 1.31) (?(2)for heterogeneityP= .69). In the sibling-matched Cox regression, this association disappeared (HR 1.03, 95% CI 0.78, 1.37). No association was found between assisted VD or emergency CS and psychosis. This study found that elective CS is associated with an increase in offspring psychosis. However, the association did not persist in the sibling-matched analysis, implying the association is likely due to familial confounding by unmeasured factors such as genetics or environment.
Notes
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PubMed ID
26615187 View in PubMed
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Cancer pathways are associated with improved long-term survival.

https://arctichealth.org/en/permalink/ahliterature266693
Source
Dan Med J. 2015 Feb;62(2)
Publication Type
Article
Date
Feb-2015
Author
Kenneth Højsgaard Jensen
Pierre Jean-Claude Maina
Source
Dan Med J. 2015 Feb;62(2)
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Colonic Neoplasms - mortality - surgery
Critical Pathways - statistics & numerical data
Databases, Factual
Denmark - epidemiology
Elective Surgical Procedures - mortality
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Prognosis
Proportional Hazards Models
Prospective Studies
Rectal Neoplasms - mortality - surgery
Referral and Consultation - statistics & numerical data
Retrospective Studies
Survival Rate
Time Factors
Abstract
The impact of cancer patient pathways (CPP) on long-term outcome after surgery for colorectal cancer has not been documented. This study aimed to investigate the effect of CPP on survival in patients who underwent surgery for colorectal cancer.
This was a retrospective cohort study performed in a single centre on prospectively collected data from a national database, the Danish Colorectal Cancer Group. In total, we reviewed 309 consecutive patients (145 females) with a median age of 70 years (range: 30-92 years), who underwent surgery for colorectal cancer between 2007 and 2009.
A total of 148 patients who underwent elective surgery after the introduction of CPP on 1 April 2008 had a decrease in the median number of days from referral to endoscopy (from 8 to 6, p = 0.001, from referral to oncological treatment (from 46.5 to 32 days, p
PubMed ID
25634507 View in PubMed
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Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden.

https://arctichealth.org/en/permalink/ahliterature296652
Source
Br J Surg. 2018 04; 105(5):520-528
Publication Type
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
04-2018
Author
A Karthikesalingam
M J Grima
P J Holt
A Vidal-Diez
M M Thompson
A Wanhainen
M Bjorck
K Mani
Author Affiliation
St George's Vascular Institute, St George's University of London, London, UK.
Source
Br J Surg. 2018 04; 105(5):520-528
Date
04-2018
Language
English
Publication Type
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Age Factors
Aged
Aortic Aneurysm, Abdominal - mortality - surgery
Elective Surgical Procedures - methods
Endovascular Procedures - methods
England - epidemiology
Female
Follow-Up Studies
Hospital Mortality - trends
Humans
Male
Prognosis
Retrospective Studies
Risk factors
Sex Factors
Survival Rate - trends
Sweden - epidemiology
Time Factors
Treatment Outcome
Abstract
There is substantial international variation in mortality after abdominal aortic aneurysm (AAA) repair; many non-operative factors influence risk-adjusted outcomes. This study compared 90-day and 5-year mortality for patients undergoing elective AAA repair in England and Sweden.
Patients were identified from English Hospital Episode Statistics and the Swedish Vascular Registry between 2003 and 2012. Ninety-day mortality and 5-year survival were compared after adjustment for age and sex. Separate within-country analyses were performed to examine the impact of co-morbidity, hospital teaching status and hospital annual caseload.
The study included 36?249 patients who had AAA treatment in England, with a median age of 74 (i.q.r. 69-79) years, of whom 87·2 per cent were men. There were 7806 patients treated for AAA in Sweden, with a median of age 73 (68-78) years, of whom 82·9 per cent were men. Ninety-day mortality rates were poorer in England than in Sweden (5·0 versus 3·9 per cent respectively; P?
PubMed ID
29468657 View in PubMed
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59 records – page 1 of 6.